James C. Spilsbury

Remission and incidence of obstructive sleep apnea from middle childhood to late adolescence.

STUDY OBJECTIVE To study the incidence, remission, and prediction of obstructive sleep apnea (OSA) from middle childhood to late adolescence. DESIGN Longitudinal analysis. SETTING The Cleveland Childrens Sleep and Health Study, an ethnically mixed, urban, community-based cohort, followed 8 y. PARTICIPANTS There were 490 participants with overnight polysomnography data available at ages 8-11 and 16-19 y. MEASUREMENTS AND RESULTS Baseline participant characteristics and health history were ascertained from parent report and US census data. OSA was defined as an obstructive apnea- hypopnea index ≥ 5 or an obstructive apnea index ≥ 1. OSA prevalence was approximately 4% at each examination, but OSA largely did not persist from middle childhood to late adolescence. Habitual snoring and obesity predicted OSA in cross-sectional analyses at each time point. Residence in a disadvantaged neighborhood, African-American race, and premature birth also predicted OSA in middle childhood, whereas male sex, high body mass index, and history of tonsillectomy or adenoidectomy were risk factors among adolescents. Obesity, but not habitual snoring, in middle childhood predicted adolescent OSA. CONCLUSIONS Because OSA in middle childhood usually remitted by adolescence and most adolescent cases were incident cases, criteria other than concern alone over OSA persistence or incidence should be used when making treatment decisions for pediatric OSA. Moreover, OSAs distinct risk factors at each time point underscore the need for alternative risk-factor assessments across pediatric ages. The greater importance of middle childhood obesity compared to snoring in predicting adolescent OSA provides support for screening, preventing, and treating obesity in childhood.

Summary of Issues and Challenges in the Use of New Technologies in Clinical Care and With Children and Adolescents With Chronic Illness

New technologies such as telehealth and Internet-based interventions provide powerful methods of clinical intervention and research with pediatric populations, especially children with chronic health conditions. Barriers to utilization of these technologies include the experiences and attitudes of professionals and families, ethical concerns about privacy and confidentiality resources, and control. The utilization of new technologies will be promoted by addressing resistance toward and discomfort of new technology, enhancing ways of providing information via technology, and facilitating education efforts within the general population. Recommendations to advance research concerning new technologies include the following: (a) develop benchmarks for evaluations, (b) use quantitative and qualitative approaches, (c) conduct theory-guided research, (d) study the cost benefits of different technologies, (e) document the impact of technologies on comprehensive outcomes, and (f) facilitate multisite research collaboration.

Sleep as a mediator in the pathway from violence-induced traumatic stress to poorer health and functioning: a review of the literature and proposed conceptual model

Millions of children are exposed to various forms of violence every year, resulting—for many of them—in psychological problems, decreased social functioning, and poorer overall quality of their relationships and lives. This article reviews the scientific literature investigating the role of sleep as a key mediator in the pathway between violence-induced traumatic stress and resulting negative health and behavioral outcomes. Based on evidence revealed by this review and general research on how exposure to violence influences child health and development, a conceptual model is proposed that posits sleeps role as an important mediator of health effects and that incorporates other factors believed to shape linkages between exposure to violence and health and behavioral outcomes in children. Recommendations are given for future research to test the proposed model.

Psychometric Properties of the Pediatric Emotional Distress Scale in a Diverse Sample of Children Exposed to Interpersonal Violence

This study determined psychometric properties of the Pediatric Emotional Distress Scale (PEDS) with an ethnically diverse sample of 383 children 2 to 7 years of age exposed to interpersonal violence and participating in a community-based intervention. Means and alpha coefficients for the total scale and 3 subscales fell within previously reported parameters. Separate exploratory factor analysis and confirmatory factor analysis using structural equation modeling revealed that compared to the PEDSs 3-factor structure (Anxious/Withdrawn, Fearful, Act Out), a modified PEDS model with 2 latent factors (Act Out and Internalize) better fit the data and also held for both African American and White subsamples. Different correlations between the two factors and the Revised Behavior Problem Checklist further suggested that the factors represented unique latent constructs and gave evidence of construct validity. The modified PEDS could potentially be used for screening children exposed to violence.

Association between children's exposure to a violent event and objectively and subjectively measured sleep characteristics: a pilot longitudinal study

Although sleep disturbances are commonly reported among children exposed to violence, objective evidence of such disturbances is rare. This longitudinal, home‐based study assessed the effects of a known community‐ or family‐violence incident on both actigraphy‐derived and subjectively reported sleep outcomes of an ethnically mixed, urban sample of children aged 8–16 years. We hypothesized that increased event severity (child physical assault, witnessed homicide) would be associated with lower sleep duration and poorer sleep quality both at baseline and at 3‐month follow‐up. Covariate‐adjusted analyses based on a generalized estimating equations approach showed that children physically assaulted during the event showed lower sleep duration and sleep efficiency and greater wake after sleep onset than those not physically assaulted. Physically assaulted children were more likely to have a later bedtime than non‐assaulted children, but this difference decreased at 3 months. Children witnessing a homicide showed greater wake after sleep onset at baseline and reported greater sleep problems than those witnessing a non‐homicide event, but these differences decreased at 3 months. They were also somewhat more likely to have greater nightly variation in sleep duration. Collectively, results suggest that violence exposure influences childrens sleep, but that specific dimensions of sleep may exhibit different susceptibility to different characteristics of violence, especially over time.

Psychometric Properties of the Dimensions of Stressful Events Rating Scale

Unlike other instruments designed to assess DSM-IV Criterion A for posttraumatic stress disorder, exposure to a high-magnitude stressor, the Dimensions of Stressful Events (DOSE) scale assesses not different types of stressors but the specific characteristics of high-magnitude stressor events that the literature indicates increase the likelihood of posttraumatic response to the stressful event(s). This study investigated the DOSEs psychometric properties in a sample of 1,032 children aged 2 to 18 years (mean = 8.5 ± 3.9) exposed to interpersonal violence who participated in a community-based intervention. Findings indicate that the DOSE shows promise as a valid and reliable measure of the traumatic potential associated with diverse stressful experiences. Clinically, it could also be used as an indirect screening measure of the potential for the development of acute or posttraumatic stress disorder. In addition, the DOSE may allow researchers to make comparisons of the impact of different high-magnitude s...

Sleep Environments of Children in an Urban U.S. Setting Exposed to Interpersonal Violence.

This study investigated how violence influences children’s sleep environments. Sixty-five children ages 8–16 years and a parent or guardian were recruited from agencies serving families experiencing violence. At baseline (5 weeks post–violent event), 6 months, and 12 months postbaseline, study staff collected sleep-behavior information and conducted systematic, qualitative assessments of sleep environments. Child sleep problems were generally frequent and persistent. However, 9 children reported improved sleep after the violent event, mainly because perpetrators were no longer present. Sleeping environments were dynamic via changes in location and modifications to improve safety and sleep. Incongruence between children’s and parents’ perceptions of environmental characteristics influencing sleep was common. Families’ motivation to improve children’s sleep represents a foundation to build upon when working with families victimized by violence.

Parent-Reported Habitual Snoring and Depressive Symptoms Among Children and Adolescents Who Are Obese

Sleep disordered breathing (SDB) is associated with medical and psychological problems, including obesity and depression. Snoring is the most common complaint for SDB. We hypothesized that children and adolescents who are obese and snore would have more depressive symptoms than those who do not snore. Participants (ages 6–17) evaluated for a weight management program (n = 247) were divided into parent-reported habitual snorers (34%) and non-snorers (65%). Habitual snorers had significantly more self-reported symptoms of depression than did non-snorers (0.041); a trend remained after controlling for BMI z-scores (0.053). Clinicians should be aware of depressive symptoms in this high-risk population.

Understanding trends in neighborhood child maltreatment rates: A three-wave panel study 1990–2010

This study examines how changes in the social and economic structure of neighborhoods relate to changes in child maltreatment report rates over an extended period. The panel study design allows us to partition the changes in child maltreatment report rates into a portion associated with how the levels of socio-economic risk factors have changed over time, and a portion related to how the relative importance of those factors in explaining maltreatment report rates has changed over time. Through the application of fixed effects panel models, the analysis is also able to control for unmeasured time-invariant characteristics of neighborhoods that may be a source of bias in cross-sectional studies. The study finds that increases in vacant housing, single parent families and unemployment rates are strongly associated with increases in child maltreatment report rates. Changes in racial/ethnic composition did not produce changes in maltreatment report rates except when they reached extreme levels of segregation. Although poverty rates were predictive of cross-sectional variation in child maltreatment, increases in neighborhood poverty became less associated with increases in child maltreatment report rates over time.

Immigrant Health Care Providers in the United States

Immigrants have played a significant role in the provision of health care to Americans. The experience of immigrant physicians, nurses, and other health care providers, especially their reception by Americans, has been shaped over time by various political, social, and economic circumstances in their host country. At times they have been considered lifesavers; at other times they have been perceived as substandard practitioners (Friedman, 1979). They have been acknowledged for practicing in geographic areas and in medical specialties considered undesirable by U.S.-born citizens and have also been accused of taking jobs away from Americans. Some say that their numbers should be reduced in the United States; others say that their work is indispensable.